It's not perfect, but it can track:
Date | Time to the second | User | Operation (Insert, Sign, etc.)
Description (Created patient message, Created SOAP note, etc.)
Row ID | Originating computer
__________________________________________
What is weird about the log is that it gives the RowID (SQL database) and the audit number (SQL database).
But, at least for now, you would be able to track who did what to whom from where at what time. (If passwords were good).
You would be able to see the entire note, message, etc.
Does that solve my issue? Let's say that I'm on vacation, and I decide to log in as me to review labs. I'm at a sidewalk cafe on the
Champs Elysees, having a
really good time, and I'm not as attentive as I should be. A serum potassium of 7 slips by me (we see those all the time in my business, and hopefully we never miss their import).
My poor partner who's agreed to log in as me daily to review labs while I'm away never sees that K (because I processed it remotely), and the patient arrests before dialysis. If I'm unwilling to 'fess up that I reviewed labs from across the pond and blew my assignment, my poor partner's defense will be that he's
certain he's certain he never saw that report. However, he'd have to agree that it was his responsibility to do the lab reviews, and that he did so using my password. Can the database review indicate that this particular lab check was accomplished via a remote login? He might be saved if all the rest of his reviews were done sitting at his own desk (and the database records the computer used to process the report).
Please don't think I'm trying to belabor the obvious. However, I think it is often the case that group practices have people with very different styles and degrees of attentiveness, and the best of us in terms of our obsessive-compulsive behavior may not be seen that way by our patients (the person in our practice who is
most detail oriented has been labeled "Dr. Hi/Bye" by one of his particularly difficult dialysis patients because she doesn't think he gives her ALL the attention she deserves on dialysis rounds).
Jim Robertson
